Low Back Pain: Optimal Patient Care

The following statement may not be pleasant to read, but it is realistic: almost every adult, at some point in their life, will have back pain. It will sometimes be mild, but can also become chronic. Of all the conditions that affect the spine, low back pain is by far the most common. One of the challenges in effectively treating this complex and multifactorial condition lies in optimizing the patient’s clinical trajectory. A challenge that Professors Martin Descarreaux and Andrée-Anne Marchand, respectively from the Department of Human Kinetics and the Department of Chiropractic at the Université du Québec à Trois-Rivières (UQTR), wish to overcome by studying the integration of chiropractors into the public health system.

“Chiropractors are back pain specialists. We want to put their expertise at the service of patients’ health in the public system,” says Professor Descarreaux, himself a chiropractor and holder of the International Research Chair in Neuromusculoskeletal Health. The project he is conducting with his colleague Andrée-Anne Marchand aims to explore how chiropractors, who specialize in the diagnosis and treatment of spinal pain, can help improve the trajectory and outcomes of patients with low back pain.

“Our project emerges from a need expressed by medical specialists who wish to prioritize patients requiring expertise in neurosurgery, and thus redirect other patients to the appropriate professional,” says Andrée-Anne Marchand. The researchers’ hypothesis is based on the idea that integrating chiropractors into public health care services during triage would reduce delays as well as the number of non-indicated examinations and, consequently, contribute to improving the health of patients with low back pain.

Optimizing the patient’s trajectory

Let us take a typical case of a person with low back pain, who goes to the emergency room or to their family doctor and is referred to a neurosurgeon, who then prescribes treatment according to their condition – physiotherapy, chiropractic, kinesiology, surgery, etc.

“In this trajectory, we want the chiropractor to intercept the patient between the first line (emergency, family doctor) and the neurosurgeon. The chiropractor will perform a complete assessment, including risk factors for a poor prognosis, which will then be passed on to the neurosurgeon. In the medium term, we hope to propose a more rectilinear trajectory, with more effective management and better results on the patient’s pain and functional capacities,” explains Martin Descarreaux. The research team can also count on the collaboration of Dr. Claude-Édouard Châtillon, a neurosurgeon at the Centre intégré universitaire de santé et de services sociaux de la Mauricie-et-du-Centre-du-Québec (CIUSSS MCQ), the local integrated university health and social services center, who is acting as co-investigator for the study.

This will be carried out on 140 patients referred to the neurosurgery department of CIUSSS MCQ. Patients with low back pain will be randomly referred to triage done by a chiropractor or directly to the neurosurgeon. All patients’ files will then be analyzed to determine whether the chiropractor and the neurosurgeon agree on the nature of the condition and its possible progression. This methodology will measure the potential impact of the triage performed by the chiropractors on the patient’s trajectory.

“We hope to see gains in time and efficiency. The ultimate goal is to integrate chiropractors into interdisciplinary teams working in the public health system. The project is really designed to benefit the patient, to improve their journey through the health care system and, ultimately, to promote faster recovery,” says Professor Descarreaux.

A first in Canada

“This is the first study in Canada to use this randomized triage approach to concretely measure the impact of chiropractors’ diagnosis and treatment on a patient’s trajectory through the public health care system,” says Robert Harris, Executive Director of the Canadian Chiropractic Research Foundation (CCRF), which partnered with UQTR by providing a $50,000 grant to the UQTR researchers to conduct this project.

The CCRF, a world leader in chiropractic research, supports the scientific development of innovation in neuromusculoskeletal health through its grant programs and collaborations. Mr. Harris added that “the CCRF is pleased to be combining our resources with UQTR, notably by co-funding and creating awareness about this innovative project that aims to improve health services in Quebec and Canada.”

For Professor Andrée-Anne Marchand, the project is also good news for students enrolled in the undergraduate doctorate in chiropractic program at UQTR: “This will eventually become a practicum environment for our students, which will provide an interdisciplinary experience in the health care system. This opens the door to new ways of practicing chiropractic and, hopefully, new employment opportunities.”